Effectiveness of Medication Review Services on Diabetes Self-Care in Primary Care Patients (Preprint)

2020 ◽  
Author(s):  
Tay Siew Cheng Sarah ◽  
Lim Jit Fan Christina ◽  
Tan Soo Chieng Daphne ◽  
Tan Seok Yee Maureen ◽  
Chen Jieying Cordelia ◽  
...  
Keyword(s):  
Physical Activity ◽  
Primary Healthcare ◽  
Medication Review ◽  
Intervention Group ◽  
Self Care ◽  
Effective Intervention ◽  
Controlled Study ◽  
Control Group ◽  
Dietary Control ◽  
Glucose Management

BACKGROUND Diabetes is one of the most common medical conditions referred to medication review service run by pharmacists, OBJECTIVE This study aims to determine whether pharmacist-run MRS can be an effective intervention tool to improve patients’ participation in self-care of diabetes. METHODS This randomised controlled study was conducted in five public primary healthcare centres from December 2014 to October 2016. Participants were 40 to 80 years of age and had been diagnosed with type 2 diabetes. These participants were prescribed with five or more chronic medications, of which at least one was an antidiabetic medication, by the primary healthcare centres’ doctors. The participants were randomly recruited into the intervention or control arm. A self-developed questionnaire which incorporated the validated Diabetes Self-Management Questionnaire (DSMQ) was administered face-to-face by the study team to the participants prior to and after MRS. MRS was not administered to participants in the control group. RESULTS A total of 221 participants completed the follow up. There were 105 participants in the control arm and 116 in the intervention arm. The DSMQ Sum Scale score of the control group improved by 0.16 ± 1.11 (p= 0.136) while the intervention group improved by 0.40 ± 0.99 (p=0.000). Participants in the intervention group reported a better improvement in their self-care of diabetes, specifically in glucose management (0.38± 1.35, p=0.003), dietary control (0.26±1.66, p=0.096) and physical activity (0.67±2.36, p=0.003). CONCLUSIONS Pharmacist-run MRS is an effective intervention tool to improve participants’ self-care of diabetes, particularly in glucose management, dietary control and physical activity.

Effect of a 12-week workplace interview intervention on physical activity and low back pain: a single-center, randomized controlled study

2020 ◽  
Author(s):  
Kazuhiro Shimo ◽  
Mami Hasegawa ◽  
Seiko Mizutani ◽  
Tomomi Hasegawa ◽  
Takahiro Ushida
Keyword(s):  
Physical Activity ◽  
Low Back Pain ◽  
Back Pain ◽  
Physical Therapist ◽  
Intervention Group ◽  
Office Workers ◽  
Controlled Study ◽  
Control Group ◽  
Low Back ◽  
Face To Face

Abstract Background Physical activity (PA) is essential in the management and rehabilitation of low back pain (LBP). However, it is not clear if workplace PA interventions can improve LBP. This study aimed to investigate the effects of workplace interview intervention on increasing PA and improving LBP among office workers. Methods We recruited 37 workers of a manufacturing company in Aichi, Japan. Participants were randomly assigned to the intervention group (n=20) or control group (n=17). We affixed waist-worn accelerometers to monitor PA in all participants, and provided face-to-face counseling with a physical therapist or nurse once a week for 12 weeks as workplace PA program to reassurance and encourage participants to keep high levels of PA. PA and LBP severity were assessed at baseline, 3 and 6 months. Results Baseline characteristics were similar in both groups, but PA was significantly higher in the intervention group than in the control group at 3 and 6 months. In the intervention group, was PA significantly increased at 3 and 6 months from baseline and LBP severity improved significantly at 6 months from baseline. We calculated the effect size of the interview intervention, and found that workplace interview intervention had a medium to large effect on PA and LBP severity. Conclusions Our data suggests that workplace PA intervention can increase PA and improve LBP among office workers. Trial registration UMIN-CTR Clinical Trial UMIN000038864 (https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000044321). Registered 12 December 2019, retrospectively registered.

scholarly journals Primary Care and Physical Literacy: A Non-Randomized Controlled Pilot Study to Combat the High Prevalence of Physically Inactive Adults in Austria

2021 ◽  
Vol 18 (16) ◽  
pp. 8593
Author(s):  
Peter Holler ◽  
Johannes Jaunig ◽  
Othmar Moser ◽  
Silvia Tuttner ◽  
Helmut Simi ◽  
...  
Keyword(s):  
Physical Activity ◽  
Pilot Study ◽  
Self Efficacy ◽  
Intervention Group ◽  
Physical Activity Behavior ◽  
Controlled Study ◽  
Control Group ◽  
Physical Literacy ◽  
Randomized Controlled ◽  
Activity Behavior

The multidimensional concept of physical literacy is fundamental for lifelong physical activity engagement. However, physical literacy-based interventions are in their infancy, especially among adults. Therefore, the purpose of this pilot study was to assess the association of a physical literacy-based intervention with changes in self-reported physical literacy among inactive adults. A non-randomized controlled study (2 × 2 design) was conducted, comparing pre- vs. postintervention. Twenty-eight inactive healthy participants in the intervention group (89% female, 53 ± 10 years) entered a physical literacy-based intervention once weekly for 14 weeks. The non-treated control group consisted of 22 inactive adults (96% female, 50 ± 11 years). Physical literacy was evaluated with a questionnaire encompassing five domains: physical activity behavior, attitude/understanding, motivation, knowledge, and self-efficacy/confidence. ANOVA models were applied to evaluate changes by time and condition. Following the intervention, significant improvements were seen for overall physical literacy and in four out of five physical literacy domains, including physical activity behavior, attitude/understanding, knowledge, and self-efficacy/confidence (all p < 0.01, Cohen’s d = 0.38–0.83). No changes by time x condition were found for motivation. The physical literacy-based intervention applied in this study may be a promising approach to help inactive adults to adopt an active lifestyle.

scholarly journals Habilidades comunicativas de enfermería para conseguir dietas adaptadas efectivas en pacientes paquistaníes con Diabetes mellitus 2 = Nursing's communication skills for effective diets adapted to Pakistani patients with diabetes mellitus-2

2017 ◽  
Vol 8 (1) ◽  
pp. 5
Author(s):  
Ainhoa Calpe Cristino ◽  
Elisabeth Fructuoso González ◽  
Montserrat Ochando Aymerich ◽  
Iñaki Fernández Martín ◽  
Montserrat Rodero Nuño ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Metabolic Control ◽  
Primary Healthcare ◽  
Intervention Group ◽  
Patient Communication ◽  
Control Group ◽  
Dietary Control ◽  
Dietary Compliance ◽  
Diabetes Mellitus Type Ii ◽  
Diabetes Mellitus 2

Resumen: Introducción: El entrenamiento de enfermería en habilidades comunicativas puede aumentar el cumplimiento dietético y mejorar el control de la Diabetes Mellitus 2 (DM-2). Nuestro grupo investigador diseñó una dieta adaptada para pacientes originarios de Pakistán con DM-2 encontrando una mejora en la adherencia y cumplimiento dietético. Objetivos: Evaluar la efectividad de una dieta adaptada a los hábitos culinarios de la población paquistaní en el control metabólico de la DM-2. Material y métodos: Ensayo clínico aleatorio desarrollado en tres Centros de Salud: “Besòs”, “Raval Sud” en Barcelona y “Fondo” en Santa Coloma de Gramanet. Criterios de inclusión: pacientes adultos con DM-2, de la nacionalidad de estudio y con Hemoglobina glicosilada (HbA1c) superior al 8%. Se incide en la comunicación profesional-paciente mediante la explicación pormenorizada de la dieta. Muestreo aleatorio consecutivo. El grupo intervención recibirá la dieta adaptada y el grupo control las medidas habituales de manejo de la DM-2. Al final del estudio, se compararán los 2 grupos para analizar las diferencias en el control metabólico de la DM-2. Resultados: Fase inicial del estudio. Hemos reclutado 19 pacientes. Un 64,7% presenta un mal control metabólico (HbA1c media=9,9; Desviación estándar=2,41). Discusión: Con las primeras visitas realizadas, se aprecia una mejora en la comunicación entre enfermera y paciente, un mejor cumplimiento de las recomendaciones y mayor satisfacción del paciente.Palabras clave: Pakistán, Hábitos de comida, Cumplimiento del paciente, Diabetes Mellitus (Tipo II), Relación paciente-profesional, Atención Primaria de SaludAbstract: Introduction: Nursing training in communicative skills can increase compliance and improve dietary control in Diabetes Mellitus-2 (DM-2). Our research group designed an adapted diet for patients from Pakistan with DM-2 where we found an improvement in adherence and dietary compliance. Objectives: Assess the effectivity of an adapted diet for Pakistani patients in the metabolic control of DM2. Evaluate the effectiveness of the diet on diabetic complications. Methodology: Random clinical trial developed in three primary healthcare centers: Besòs, Raval Sud in Barcelona and Fondo in Santa Coloma de Gramanet. Inclusion criteria: adult patients with DM2, Pakistani origin and HbA1c > 8%. This study falls upon professional-patient communication through detailed explanation of the diet.Random consecutive sample. The intervention group received the adapted diet and the control group the usual measures of DM2 control. Preliminary results: Initial phase of the study. We recruited 19 patients. 64.7% have poor metabolic control (HbA1c mean = 9.9, standard deviation = 2.41). Discussion: We appreciate an improvement in nurse-patient communication, better compliance with the recommendations and a patient satisfaction with the first visits.Keywords: Pakistan, Food habits, Patient compliance, Diabetes Mellitus (Type II), Professional-patient relationship, Primary Healthcare  

scholarly journals Effects of a 12-week workplace counseling program on physical activity and low back pain: A pilot randomized controlled study

2021 ◽  
pp. 1-8
Author(s):  
Kazuhiro Shimo ◽  
Mami Hasegawa ◽  
Seiko Mizutani ◽  
Tomomi Hasegawa ◽  
Takahiro Ushida
Keyword(s):  
Physical Activity ◽  
Low Back Pain ◽  
Back Pain ◽  
Physical Therapist ◽  
Intervention Group ◽  
Controlled Study ◽  
Control Group ◽  
Low Back ◽  
Face To Face ◽  
High Level

BACKGROUND: Physical activity (PA) is essential in the management and rehabilitation of low back pain (LBP). However, it is not clear that PA interventions in the workplace can improve LBP. OBJECTIVE: This study aimed to investigate the effects of workplace counseling on PA and LBP among workers. METHODS: We recruited 37 people with 12 weeks of LBP who worked in a manufacturing company in Aichi, Japan. Participants were randomly assigned to the intervention (n= 20) or control group (n= 17). All participants of both groups were affixed with waist-worn accelerometers to monitor PA. The intervention group also received a program of face-to-face counseling with a physical therapist or nurse once a week for 12 weeks to reassure and encourage participants to maintain a high level of PA. PA and LBP severity were assessed at baseline, 3 and 6 months. RESULTS: PA was significantly higher in the intervention group than in the control group at 3 and 6 months. In the intervention group, PA significantly increased at 3 and 6 months from baseline, and LBP severity at 6 months improved significantly from baseline. CONCLUSIONS: Our data suggest that workplace PA intervention can increase PA and improve LBP among workers.

The effects of preventive counseling followed by remote support via phone on physical activity in patients with high cardiovascular risk

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
N Pogosova ◽  
AI Yusubova ◽  
YM Yufereva ◽  
OY Sokolova ◽  
AV Karpova ◽  
...  
Keyword(s):  
Physical Activity ◽  
Standard Deviation ◽  
Intervention Group ◽  
Physical Activities ◽  
Controlled Study ◽  
Control Group ◽  
Funding Sources ◽  
Preventive Counseling ◽  
Study Intervention ◽  
Very High

Abstract Funding Acknowledgements Type of funding sources: None. Background Education may increase physical activity (PA) in patients (pts) with high cardiovascular (CV) risk. Objectives To assess the effects of preventive counseling with focus on diet modification with remote support by phone on PA levels in high CV risk pts. Methods This is a randomized controlled study of pts aged 40 to 65 years with high/very high CV risk (Systematic Coronary Risk Evaluation scale [SCORE], ≥5%) and any 2 metabolic syndrome criteria.  Pts were randomized into 2 groups in 1:1 ratio. Intervention group received comprehensive preventive counseling with focus on healthy diet followed by 3 months of biweekly remote counseling by phone (a total of 6 sessions). Control group received usual care including basic preventive counseling. PA was assessed by International Questionnaire on Physical Activity (IPAQ) at baseline, at 6 and 12 months.  Results A total of 100 pts (women, 80%, aged 59.85 ± 4.47 years) were randomized. Demographics and clinical features were balanced across groups. Despite the study intervention not focusing on PA, total PA, moderate PA and walking significantly increased in the intervention group vs control at 6 and 12 months. Conclusion The study intervention provided a significant increase of PA in high CV risk pts. Intervention group, mean ± standard deviation Control group, mean ± standard deviation P for change from baseline Total physical activities, МЕТ-min/week Baseline 1317.94 ± 1455.4 2029.42 ± 2811.84 After 6 months 2217.58 ± 1813.95*** 1793.26 ± 1863.54 &lt;0.001 After 12 months 2240.2 ± 1991.47*** 1629.48 ± 1629.02 &lt;0.001 Vigorous physical activities, МЕТ-min/week Baseline 92.8 ± 407.72 220.8 ± 881.49 After 6 months 96 ± 557.08 0 ± 0 n/s After 12 months 132.8 ± 425.66 27.2 ± 109.15 n/s Moderate physical activities, МЕТ-min/week Baseline 268.8 ± 455.28 714 ± 1390.22 After 6 months 522.4 ± 570.54*** 518.8 ± 1075.79* &lt;0.001 After 12 months 766.8 ± 1176.38** 481.6 ± 874.97* &lt;0.001 Walking, МЕТ-min/week Baseline 956.34 ± 1071.49 1094.62 ± 1344.46 After 6 months 1599.18 ± 1404.88*** 1294.46 ± 1208.88 &lt;0.05 After 12 months 1339.8 ± 1230.51** 1120.68 ± 1067.09 &lt;0.05 *р&lt;0,05;**р&lt;0,01;***р&lt;0,001 for within group comparisons vs baseline

A smartphone coaching program (“Bouge Grossesse”) improves daily physical activity in pregnant women (Preprint)

2021 ◽  
Author(s):  
Matthieu MULLER ◽  
Pandora JAMES ◽  
Philippe MERVIEL ◽  
Alain SARAUX ◽  
Yannick GUILLODO ◽  
...  
Keyword(s):  
Physical Activity ◽  
Pregnant Women ◽  
Primary Outcome ◽  
Intervention Group ◽  
Daily Physical Activity ◽  
Controlled Study ◽  
Control Group ◽  
Sedentary Behaviors ◽  
Significant Difference ◽  
The Impact

BACKGROUND Physical activity has been shown to reduce obstetrical risks however pregnant women reduce their physical activity and sedentary behaviors increase. OBJECTIVE Our aim was to evaluate the impact of a smartphone application developed to increase daily physical activity in pregnant women. METHODS We enrolled 250 pregnant women in a prospective randomized controlled study. These women were instructed to download either an intervention application called «Bouge Grossesse» (coaching program and a pedometer; n=125) or a Placebo application (pedometer only; n=125). Primary outcome was defined as a daily increase of 2000 steps/day between day 1 and day 90 or 10 000 steps/week between week 1 and week 12. Data was analyzed with intention to treat. Secondary outcomes were the number of steps at week 12 and the evolution of quality of life measured by WHO score, EIFEL score and SPIEGEL scale, and on maternal and fetal outcomes. RESULTS Patients were enrolled between August 2017 and February 2019. They were retrospectively registered after September 2018. We found a significant difference in the primary outcome between the two groups in favor of the intervention group (22.4% success vs 3.2% in the control group, P<.001) but only 43 women in the intervention group (34.4%) and 16 women in the placebo group (12.8%) completed the 12-week coaching program. There were no significant differences in the SPIEGEL, EIFEL and WHO scores. The mean number of daily steps at week 12 was significantly higher in the intervention group (6900.0 vs 4371.9, P<.001). CONCLUSIONS The mobile health intervention « Bouge Grossesse » significantly increased physical activity in pregnant women but we observed a high percentage of withdrawals from the 12-week program. CLINICALTRIAL This clinical trial was registered under the number NCT03688087 ClinicalTrials.gov.

scholarly journals Effects of a 12-week workplace counseling program on physical activity and low back pain: a pilot randomized controlled study

2020 ◽  
Author(s):  
Kazuhiro Shimo ◽  
Mami Hasegawa ◽  
Seiko Mizutani ◽  
Tomomi Hasegawa ◽  
Takahiro Ushida
Keyword(s):  
Physical Activity ◽  
Low Back Pain ◽  
Back Pain ◽  
Physical Function ◽  
Physical Therapist ◽  
Intervention Group ◽  
Controlled Study ◽  
Control Group ◽  
Low Back ◽  
High Level

Abstract Background: Physical activity (PA) is essential in the management and rehabilitation of low back pain (LBP). However, it is not clear that PA interventions in the workplace can improve LBP. This study aimed to investigate the effects of workplace counseling on PA levels, and LBP and physical function among workers.Methods: We recruited 37 people with 12 weeks of LBP who worked as office staff or machinery mechanic in a manufacturing company in Aichi, Japan. Participants were randomly assigned to the intervention group (n = 20) or control group (n = 17). All participants of both groups were affixed with waist-worn accelerometers to monitor PA. The intervention group also received a program of face-to-face counseling with a physical therapist or nurse once a week for 12 weeks to reassure and encourage participants to maintain a high level of PA. PA, LBP severity and physical function were assessed at baseline, 3 and 6 months.Results: Baseline characteristics were similar in both groups. PA was significantly higher in the intervention group than in the control group at 3 and 6 months. In the intervention group, PA and physical function significantly increased at 3 and 6 months from baseline, and LBP severity at 6 months improved significantly from baseline. We calculated the effect size of the PA workplace counseling and found that it had a medium-to-large effect on PA, LBP severity and physical function.Conclusions: Our data suggest that workplace PA intervention can increase PA and improve LBP among workers.Trial registration: UMIN-CTR Clinical Trial UMIN000038864 (https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000044321). Registered 12 December 2019, retrospectively registered.

A Randomized Controlled Study of the Effectiveness of Electrophysiological Monitoring of Dexmedetomidine in Patients with Brain Damage of Various Origins

2020 ◽  
Vol 75 (5) ◽  
pp. 490-499
Author(s):  
Yuri Y. Kiryachkov ◽  
Marina V. Petrova ◽  
Bagautdin G. Muslimov ◽  
Sergey A. Bosenko ◽  
Mikhail M. Gorlachev
Keyword(s):  
Intervention Group ◽  
Clinical Effectiveness ◽  
Protective Role ◽  
Digital Data ◽  
Controlled Study ◽  
Control Group ◽  
Average Dose ◽  
Autonomic Nervous System Dysfunction ◽  
Sympathetic Hyperactivity ◽  
Starting Dose

Background.At the same time, the main effect of the use of this drug is the elimination of the autonomic nervous system dysfunction and sympatholysis. It seems important to search for a method of indications and selection of a dose of dexmedetomidine in intensive care.Aims to improve the clinical effectiveness of the electrophysiological navigation of the prolonged use of dexmedetomidine in patients with brain pathology of various origins.Methods.The study included 83 patients 2050 days after the traumatic brain injury, anoxic damage; consequences of acute disorders of cerebral. 37 patients comprised the 1st intervention group with a clinical course of dexmedetomidine (male 28; female 9; average age 49.62.3 years) and 46 patients comprised the 2nd control group without pharmacological correction with dexmedetomidine (male 23; female 23, average age 512.5 years). Criteria for the inclusion of prolonged infusion of the drug dexmedetomidine (Orion Pharma, Finland) are based on heart rate variability (HRV) indicators characteristic of sympathetic hyperactivity, the target task of titration of doses of dexmedetomidine served as the parameters for achieving normal HRV indicators, the appearance of parasympathetic hyperactivity served as the basis for reducing the dosage of the drug or stopping it of application. HRV parameters were recorded before dexmetomedine infusion-initially, on 13; 45; 910; 1520 days of drug administration.Results.The starting dose of dexmedetomidine with sympathetic hyperactivity in patients was 0.12 to 0.24 g.kg1.hr1(average dose 0.160.01; total 200 mg/day). According to digital data from HRV, the effective dose of dexmedetomidine ED50 was 0.260.03 g.kg1.hr1(total daily 353.835.1 g) and was achieved on day 910 using dexmedetomidine.Conclusions.The protective role of dexmedetomidine with correction of sympathetic hyperactivity based on electrophysiological navigation according to the HRV is reliable in the following indicators: The improvement of consciousness; a significant decrease in the incidence of distress lung syndrome; septic shock; mortality.

RESULTS OF LOWER GENITAL TRACT INFECTION INTERVENTION AMONG KHMER WOMEN OF CHILDBEARING AGE IN CAN THO IN 2016

2018 ◽  
pp. 83-89
Author(s):  
Trung Thuan Phan ◽  
Dinh Binh Tran ◽  
Thanh Hue Dinh ◽  
Phong Son Dinh ◽  
Kieu Oanh Truong ◽  
...  
Keyword(s):  
Genital Tract ◽  
Common Knowledge ◽  
Intervention Group ◽  
Effective Intervention ◽  
Control Group ◽  
Childbearing Age ◽  
Lower Genital Tract ◽  
Genital Tract Infections ◽  
Tract Infections ◽  
Can Tho City

Objectives: To find a model that is effective intervention to reduce the incidence of lower genital tract infections in Khmer women. Subjects and Methods: The intervention study is carried which compared the test group with the control group of 400 Khmer women, aged 15 to 49 in Can Tho city. Results: The common knowledge of the prevention of lower genital tract infections in the intervention group increased from 30.9% in the control group to 54.5% in the intervention group. The general attitude toward the use of lower genital tract infections increased from 22.3% in the control group to 78.0% in the intervention group. This is a very significant improvement. The prevalence of subclinical infection of the intervention group (26.0%) was significantly lower than that of the control group (39.3%), the difference was statistically significant. Conclusion: Intervention effectiveness is good in both knowledge, attitudes and practices, especially the effectiveness of interventions in practice in Khmer women. Key words: Effective intervention, lower genital tract infections, Khmer women, Can Tho city

A patient-centered mobile intervention to promote self-management and improve patient outcomes in chronic heart failure: The ManageHF4Life trial (Preprint)

2020 ◽  
Author(s):  
Michael P. Dorsch ◽  
Karen B. Farris ◽  
Brigid E. Rowell ◽  
Scott L. Hummel ◽  
Todd M. Koelling
Keyword(s):  
Heart Failure ◽  
Mobile Application ◽  
Controlled Trial ◽  
Intervention Group ◽  
Self Care ◽  
Self Management ◽  
Control Group ◽  
Patient Centered ◽  
Self Monitoring ◽  
Heart Failure Questionnaire

BACKGROUND Successful management of heart failure (HF) involves guideline based medical therapy as well as self-care behavior. As a result, the management of HF is moving toward a proactive real-time technological model of assisting patients with monitoring and self-management. OBJECTIVE Evaluate the effectiveness of a mobile application intervention that enhances self-monitoring on health-related quality of life, self-management, and reduces HF readmissions. METHODS A single-center randomized controlled trial was performed. Patients greater than 45 years of age and admitted for acute decompensated HF or recently discharged in the past 4 weeks were included. The intervention group used a mobile application (App). The intervention prompted daily self-monitoring and promoted self-management. The control group (No App) received usual care. The primary outcome was the change in Minnesota Living with Heart Failure Questionnaire (MLHFQ) from baseline to 6 and 12 weeks. Secondary outcomes were the Self-Care Heart Failure Index (SCHFI) questionnaire and recurrent HF admissions. RESULTS Eighty-three patients were enrolled and completed all baseline assessments. Baseline characteristics were similar between groups with the exception of HF etiology. The App group had a reduced MLHFQ at 6 weeks (37.5 ± 3.5 vs. 48.2 ± 3.7, P=0.039) but not at 12 weeks (44.2 ± 4 vs. 45.9 ± 4, P=0.778) compared to No App. There was no effect of the App on the SCHFI at 6 or 12 weeks. The time to first HF admission was not statistically different between the App versus No App groups (HR 0.89, 95% CI 0.39-2.02, P=0.781) over 12 weeks. CONCLUSIONS The mobile application intervention improved MLHFQ at 6 weeks, but did not sustain its effects at 12 weeks. No effect was seen on HF self-care. Further research is needed to enhance engagement in the application for a longer period of time and to determine if the application can reduce HF admissions in a larger study. CLINICALTRIAL NCT03149510

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